Thread by @abbyliberty1

Kyle Latack, MD from @UMichOBGYN_Res speaking about Copper v Hormonal IUD breakage reporting with the @US_FDA Adverse Event Registry

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@UMichOBGYN_Res @US_FDA Reports of IUD breakage is increasingly common in the media.

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They found 170,215 events of which 6,284 represented mechanical breakdown or breakage reports.

These were more frequent among copper IUD with an OR 6.19.

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Individuals reporting breakage events were:
- Older
- Higher weight

Latack reports that the clinical significance of these differences is not known.

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Clinicians were more likely than patients to report IUD breakages as an adverse event.

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Latack reviews that the difference in breakage between copper and hormonal IUDs may be related to the arm mechanics. Copper IUDs arms rise to the sides whereas hormonal IUDs release downward.

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Audience: Could the difference between copper and hormonal IUD breakages be related to a difference in the plastics in the IUD bodies?

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Audience: Why did you look at weight as a covariate?

Latack: Imaging studies suggest weight might increase the chance of IUD malposition (presumably at the time of placement).

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Audience: There are alternative copper IUDs in Europe which are loaded and deployed differently. Looking at breakage in those IUDs might provide insight into whether the mechanism of placement is a risk factor for breakage.

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Prior to 2021, 1.6% of women reported they have ever tried or used something to try to end a pregnancy on their own.

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In 2021, they changed the question to include examples such excessive drinking/physical injury to end a pregnancy and found that more people reported trying these.

Including these actions, 2.3% of women reported having tried to end a pregnancy on their own.

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Comparing the self managed abortion estimates to abortion estimates from @Guttmacher, it appears that self managed abortion is underreported. After adjusting for this, the study estimates that 4% of women have tried to end a pregnancy.

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The most common methods people reported included:
- Herbs: vitC, cohosh, parsley
- Substances: alcohol, fentanyl, TCH
- Medicines: OCPs or EC
- Violence: hitting their stomach

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A common reason for trying self managed abortion: thinking parental consent was required for pursing an abortion within the healthcare setting

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Self managed abortion (SMA) was effective in ending a pregnancy in 43% of pregnancies when using the more inclusive definition of SMA.

5.5% had an adverse event requiring transfusion or hospitalization

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Audience: How can you protect respondent confidentiality in studies of self managed abortion when you partner with companies such as @ipsosus?

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Audience is worried that although self managed abortion with mife/miso or miso only is thought to be highly effective, that broadening the definition of SMA to include less effective methods might confuse messaging about the safety/efficacy of SMA.

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This session has had great audience questions from @Guttmacher, @Pop_Council, @ifwhenhow... clearly SMA is an active area.

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